Positive Choice: Interactive Video Doctor

Positive Choice is a computer-based intervention designed to increase screening and counseling among HIV-positive patients for substance use and ongoing risky sexual practices. Patients waiting for a visit with a health care provider are asked to complete the first Positive Choice risk assessment on a laptop computer. The computer program uses the results of the risk assessment to formulate a personalized and interactive risk reduction message for the patient which is delivered by a “video doctor.”

The “video doctors” are actors who employ the principles of Motivational Interviewing in their virtual counseling session. The approach is patient-centered and the video doctors speak to the patient in a non-judgmental tone for 24 minutes. After the session, two documents are printed for the user. The first document is an educational worksheet for participants and includes questions that the patients can reflect on their own time. The patients can provide the second document to their health care provider; this sheet contains a summary of the patient’s risk profile and details on their readiness to change. Health care providers can use this sheet in their regularly scheduled visit to discuss changing sexual practices, drug use and suggest resources that meet the needs of the patient. Three months after the initial computer session, a “booster” session is offered to the patient and in this session the patients get feedback regarding the changes they have made since the initial visit, along with an updated output for the patient and provider to review during the clinic visit.

To eliminate or reduce sex risk behaviors and eliminate or reduce illicit drug use among HIV-positive clinic patients.

The Project Choice intervention was evaluated in San Francisco, CA between 2003 and 2006. Participants for the intervention study were recruited from outpatient HIV clinics located in public hospitals, a community-based organization, a private hospital, and a health maintenance organization. HIV-positive clinic patients were eligible if they were 18 years of age or older and had been diagnosed as HIV-positive at least 3 months previously. Those who enrolled in the study were randomly assigned to receive the Project Choice intervention or the care that is standard for the location of recruitment. The evaluation study found that intervention participants who reported unprotected sex in the initial risk assessment were significantly less likely to report unprotected anal or vaginal sex 3 months after the initial “video doctor” session (p-value = 0.006) and 3 months after the booster counseling session (p-value = 0.006) when compared with the participants who received standard care. Similarly, among participants who reported any drug use at baseline, intervention participants were significantly less likely than comparison participants to report drug use at the 3-month follow-up periods (p-values = 0.029 and < 0.001, respectively).